APPLICANT'S ABSTRACT: The goal of the study is to determine ways to reduce HIV risk behaviors in injection drug users. In the present study, we suggest that the co-occurrence of alcohol involvement and injection drug use-in persons who have already begun risk reduction by using needle exchange-provides the opportunity to motivate the patient to initiate changes in hazardous alcohol use and thereby further enhance HIV risk reduction. The Primary Aim of the present application is to test if a brief alcohol intervention-using motivational enhancement techniques (MET) in conjunction with an Alcoholic-Anonymous-type model of having a crisis counselor-will reduce HIV risk behaviors among needle exchange clients compared to a "control" intervention using a randomized trial design. The Secondary Aims are: 1) to determine if reduction in alcohol use intensity is associated with reduction in HIV risk behaviors; 2) to describe specific patient characteristics associated with reduction in HIV risk behaviors; 3) explore time trends in HIV risk behaviors across the two groups over the six month study period. Needle exchange clients who visit the research site will be assessed for probability of hazardous alcohol consumption, defined as testing positive on the AUDIT. We will then randomize 290 consenting subjects to one of two experimental conditions: (1) research assessment alone ("control condition") or (2) research assessment plus Motivational Enhancement Technique (MET). Both groups will have follow up face-to-face research assessments planned for 1 and 6 months later. The co-occurrence of hazardous alcohol use and injection drug use in a population with traditionally poor linkage to primary care, an enormous burden of illness and HIV risk, compels health care providers and policy makers to explore innovative approaches to improve the health of this group and decrease new HIV infections, particularly as Health Maintenance Organizations assume Medicaid contracts for the care of these patients.